Jet stream related iatrogenic retinal breaks during vitreo-retinal surgery

Purpose: To evaluate the causes of jet stream injury (JSI)?related iatrogenic retinal breaks (IRBs) during vitreoretinal surgery (VRS). Methods: The precise surgical environment, which includes the indication and type of surgical procedure, retina status, details of instrumentation and fluidic parameters, and characteristics of the jet responsible for the IRB, was noted from case records. The nature of IRB and its healing and impact on anatomical and visual outcomes were analyzed. Results: Five eyes of five patients with complete documentation of both the JSI and the IRB were included. Two cases were operated for macular hole, and one each for vitreous hemorrhage, retinal detachment, and endophthalmitis. One case had infusion?fluid?related JSI, while four developed it because of injection of surgical adjuncts (drugs, PFCL, and dye). JSI developed in two cases when the vitreous cavity was filled with fluid, while it was air?filled in three cases. In four cases, the fluid migrated into subretinal space, necessitating further maneuvers following which the breaks healed, but were directly responsible for vision loss in two cases. Conclusion: JSI related IRBs are rare but may be directly responsible for vision loss if they impact the macula. The balance between jet stream velocity, its distance from the retinal surface, the intervening media (vitreous cavity), and retinal health play an important role. It can occur because of both infusion as well as injection jets. Precautions must be taken in cases vulnerable to complications with suggested modifications in the surgical technique.

Effects of internal limiting membrane peeling during macular hole surgery on retinal anatomical and functional outcomes / 中华实验眼科杂志

Idiopathic macular hole (IMH) refers to full thickness defects of retinal neuroepithelial layer in macular area without clear reasons,and the combination of pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) is a standard procedure for macular hole.This technique can improve anatomical success and reduce the tangential forces,and thus accelerating the macular hole closure.With increasing use of ILMP and vital dye,the controversial issue of the intentional ILMP has arisen.First,the earliest change in the macula after ILMP is postoperative swelling of the arcuate retinal nerve fiber layer and dissociated optic nerve fiber layer occurs later in the postoperative period;second,retinal thickness modification,such as the thinning of retinal nerve fiber layer (RNFL),ganglial cell layer (GCL) and inner plexiform layer (IPL);third,displacement of foveal area toward optic disc and decrease of the foveal avascular zone area decrease retinal sensitivity and changes of the focal macular electroretinogram.This article reviewed the effects of ILMP during macular hole surgery on retinal anatomical and functional outcomes.

Effect of light damage on the function of blood-retinal barrier in rats / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AIM: To investigate the influence on blood-retina barrier after intense light exposure in rats.?METHODS: The rats were randomly divided into light exposure group and control group. Rats in light exposure group were exposed in white light (10000lux, 12h on-off, continuing 1-14d) .Rats in control group were only exposed in natural light.The eyes of the rats in the two groups were removed when the rats in light exposure group acceptted intense light after 1, 3, 7 and 14d.We observed the change of retinal structure using hematoxylin-eosin ( HE ) staining, and observed the change of retinal ultrastructure using electron microscope.We quantified the change of retinal vascular permeability using laser scanning confocal fluorescence microscope and spectrophotometry after perfusion of Evans-blue, to evaluate the change of blood-retinal barrier.?RESULTS: At 1d after intense light exposure, the retinal ultrastructure of rats changed, such as denaturation of photoreceptor cells and falling of membranous disc outer segment and thinning of the outer nuclear layer thickness, and so on;and the longer the rats exposure to intense light, the more serious change of the retinal ultrastructure were found.At 3d later, photoreceptor cells began apoptosis.At 14d later, the outer nuclear layer became thinner obviously, and the number of cells reduce obviously.At 1d after intense light exposure, EB leaked from the retinal vascular, and at 14d later the leaking of EB was more obvious.?CONCLUSION: The photoreceptor cell of the outer nuclear layer of retina will degenerate and apoptosis, and the outer nuclear layer will be thinner, and the structure and function of blood-retinal barrier will be destroied, if the eyes of rats exposed in intense light.

The Effects of Resveratrol via Mediation of Nitric Oxide Synthase (NOS) on Hypoxic Retinal Injury in Neonatal Rats / 대한주산의학회잡지

PURPOSE: Retinopathy of prematurity (ROP) is one of the leading causes of blindness, with retinal detachment occurring due to oxygen toxicity in preterm infants. After premature delivery, oxygen levels are significantly increased compared to those in utero and oxygen therapy further increases oxygen levels in the developing retina. This hyperoxia results in reducing vascular endothelial growth factor (VEGF) level. After the cessation of oxygen therapy and the return to normal oxygen levels, the nonperfused portions of the retina become hypoxic. Retinal hypoxia stimulates VEGF which causes retinal neovascularization and retinal proliferation. Further inhibition of VEGF decreases retinal neovascularization. Recently, resveratrol was found to protect the spinal cord, kidney, and heart from ischemia-reperfusion injury through upregulation of nitric oxide (NO). Resveratrol has been reported to either suppress or enhance NO production. Resveratrol inhibits nitric oxide synthase (NOS) activity and modifies inducible nitric oxide synthase (iNOS) expression. In the present study, we aimed to determine whether or not resveratrol exhibits protective effects via mediation of NOS after a hypoxic retinal insult. METHODS: In the in vitro hypoxic retinal injury, primary retinal cell culture was performed using P0-2 Sprague-Dawley (SD) rats. Hypoxia insults were induced through 1% O2 exposure for sixteen hours. Western blotting and real-time PCR using iNOS, endothelia nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS) antibodies and mRNAs were performed. RESULTS: The expressions of iNOS antibody and mRNA were reduced after a hypoxic insult, whereas it was recovered after treatment with resveratrol. In contrast, those of eNOS and nNOS showed reversely. CONCLUSION: Resveratrol appeared to exert retinal protective effects via mediation of NOS on hypoxic retinal injury in neonatal rats.

A Case of Retinal Injury During a Laser Show

PURPOSE: To report a case of macular injury after exposure to a high energy laser beam used in a laser show. CASE: A 19-year-old female presented 2 days after exposure to a high energy laser beam at a laser show in a night club with decreased vision in her right eye. The patient's best corrected visual acuity of the right eye was hand motion. Fundus examination reveald a retinal swelling in the macular area approximately 5 disc diameter in size and a submacular hemorrhage. Fluorescein angiography of the right eye showed marked hypofluorescence in the macular area and optical coherence tomography (OCT) showed a neurosensory retinal detachment with a macular edema. Three years after exposure, the visual acuity of the right eye improved to 20/600. The fundus revealed scar and depigmented area at the macula. CONCLUSIONS: High-energy laser devices at laser shows should be used carefully with safety education and strict control and can provoke irreversible eye damage if not managed adequately.

A Case of Accidental Macular Injury by Nd: YAG Laser and Subsequent 6 Year Follow-Up

Here, we report the case of a patient who sustained Nd: YAG laser macular injury with subsequent 6 year follow-up evaluation. A 23-year-old female was accidentally exposed to a Q-switched Nd: YAG laser without protective goggles. Upon initial evaluation, the best-corrected visual acuity of her affected eye was 20/100 OD. Fundoscopic examination revealed a macular laser burn and vitreous hemorrhage. Corticosteroids, in the form of 60 mg prednisolone, were administered orally with a 10 mg per week taper. Nineteen days following exposure, fundoscopic examination revealed a distinct epiretinal membrane which resolved within six months. The best-corrected visual acuity of the affected eye remained 20/100 OD. This clinical course is similar to those of previously reported cases including vitreous hemorrhage and subsequent epiretinal membrane formation. However, visual acuity did not recover despite spontaneous regression of the epiretinal membrane and at 6 year follow-up, there was neither choroidal neovascularization nor macular hole formation.

A Case of Needleless Jet Injector Induced Bilateral Chorioretinal Injury

PURPOSE: To report a case of bilateral chorioretinal injury by needleless jet injector misuse. CASE SUMMARY: In a dermatology department, the patient was diagnosed as having total alopecia and was scheduled to be injected on her eyelash by needleless jet injector for treatment but inexpert doctor injected on the eyelid, not eyelash, by mistake. She then suddenly complained of blurred vision and a floater just after that procedure and was referred to the ophthalmology department. Bilateral vitreous hemorrhage and preretinal hemorrhage were seen during indirect ophthalmoscopic examination and bilateral prophylactic argon laser photocoagulation was done around the suspicious tear site. Then bilateral vitreous hemorrhage and preretinal hemorrhage were absorbed and we found a partial retinal rupture lesion and choroidal rupture lesion in the right eye and a retinal injury lesion in the lefteye. Therefore we observed the lesions of both eyes continuously without further treatment. Her clinical symptoms improved. CONCLUSIONS: Needleless jet injector has many advantages, especially less pain and injury than a normal needle injector and is usually used in clinic as preoperative local anesthesia and steroid injection in many medical fields. In this case, the needleless injector was accidentally misused inducing both direct and indirect choroidal rupture and retinal injury. In general, while a needleless jet injector is used in ophthalmology department, we have to use it with the greatest care.

A Case of Photic Retinal Injury Associated with Exposure to Plasma Arc Welding

PURPOSE: To report of photic retinopathy induced by plasma arc welding, and the OCT (optical coherence tomography) results of damaged retinal lesions. METHODS: We describe a case report of a 37-year-old male, working in the steel industry, who presented with central scotoma in both eyes. RESULTS: On his first visit, one day after performing plasma arc welding with protective gear at work, his best corrected vision was 0.7 for both eyes. Ophthalmic examination of the fundus showed a round yellow lesion with an approximate size of 300 micrometers superonasal to the fovea of both eyes. On his next visit, one month later, his vision had recovered to 1.0, his symptoms had improved, and the ophthalmoscopic examination of the fundus revealed that the round yellow spots had disappeared from both eyes. CONCLUSIONS: To our knowledge, this is the first report of photic retinopathy induced by plasma arc welding, and the OCT (optical coherence tomography) results of damaged retinal lesions have not previously been reported. For these reasons, we report this case.

Neuroprotection Effect of Ascorbic Acid in Model of Ischemic Retinal Injury

PURPOSE: An attempt to establish the neuroprotection effect of ascorbic acid in ischemic retinal injury. METHODS: A rat anterior chamber was cannulated with a 30-gauge infusion needle connected to a container of balanced salt solution (BSS). The container was raised to a height of 3m during 60mins, thereby inducing retina ischemia by high intraocular pressure (HIOP). The effect of ascorbic acid was demonstrated by hematoxylin-eosin (H and E) stain and neuronal nitric oxide synthase (nNOS) immunohistochemical stain. The effect was classified into three HIOP-induced groups: without ascorbic acid treatment, ; ascorbic acid-treated at 24 hr and just before experiment; and ascorbic acid-treated at 24hr, just before experiment and every 24hr after experiment. RESULTS: After retinal ischemia, in the ascorbic acid-treatment groups (Ed- confirm the plural here; from above there are two ascorbic acid-treated groups), the thickness of each retinal layer was preserved more than that in the non-ascorbic acid treated group. There was little difference according to ascorbic acid administration time and period. By nNOS immunohistochemical stain, in the non-ascorbic acid administration group, nNOS immune reactive cells were increased remarkably, in the Inner Nuclear layer (INL) and Ganglion Cell Layer (GCL). In the ascorbic acid-treated groups (Ed-agin confirm), nNOS immune reactive cells were stained in a similar pattern to that of the control group. CONCLUSIONS: The neuroprotection effect of ascorbic acid in ischemic retinal injury was demonstrated, as was the suppression of nNOS expression in the ischemic retina tissue by ascorbic acid administration.

Photic Retinal Injury Induced by Endoillumination during Vitrectomy

Photic retinal injuries following operating microscopic light exposure or endoillumination are produced by mechanical, thermal or photochemical mechanism. The authors experienced a case of a patient who developed a round macular lesion which seemed to be a light-induced retinal damage during pars plana vitrectomy and removal of intraretinal foreign body.

Proliferative Effect of Retinal Glial Cells by Growth Factors

The authors tried to evaluate the effect of the growth factors on cell proliferation in the human retina astrocyte culture. Each growth factor, EGF, bFGF, GGF, IGF-1 or PDGF, together with BrdU was added to astrocytes-enriched cultures in the serum-free media. The proliferating effect of each growth factor was evaluated by a double immunofluo- rescenece labelling for GFAP and BrdU. By and addition of each growth factor, the number of retinal astrocytes at the synthetic stage significantly increased than those of control group (p<0.01). In comparision, PDGF was more potent than IGF-1 (p<0.01). Above data extended the concept of astrocytic proliferation caused by several growth factors in human retinal injury.